CN112805010A - Dietary fiber for treating patients with methylmalonic acidemia and propionic acidemia - Google Patents

Dietary fiber for treating patients with methylmalonic acidemia and propionic acidemia Download PDF

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Publication number
CN112805010A
CN112805010A CN201980065752.7A CN201980065752A CN112805010A CN 112805010 A CN112805010 A CN 112805010A CN 201980065752 A CN201980065752 A CN 201980065752A CN 112805010 A CN112805010 A CN 112805010A
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CN
China
Prior art keywords
composition
dietary
use according
mma
fiber
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CN201980065752.7A
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Chinese (zh)
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M·库恩
M·拉赫尚德鲁
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Nutricia NV
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Nutricia NV
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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    • A61K31/702—Oligosaccharides, i.e. having three to five saccharide radicals attached to each other by glycosidic linkages
    • A—HUMAN NECESSITIES
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    • A23L29/00—Foods or foodstuffs containing additives; Preparation or treatment thereof
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    • A23L29/212—Starch; Modified starch; Starch derivatives, e.g. esters or ethers
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Abstract

The present invention relates to a composition comprising dietary fibre for use in the dietary Management of Methylmalonic Acidemia (MMA) and/or Propionic Acidemia (PA), and/or for use in the treatment and/or alleviation of MMA and/or PA, and/or treatment, alleviation and/or prevention of symptoms associated therewith.

Description

Dietary fiber for treating patients with methylmalonic acidemia and propionic acidemia
Technical Field
The present invention relates to the field of dietary Management of Methylmalonic Acidemia (MMA) and Propionic Acidemia (PA), and to the field of use for treating symptoms associated therewith.
Background
Patients with Organic Aciduria (OA) suffer from a rare congenital metabolic defect. The largest disorders in OA are methylmalonic acidemia (MMA) and Propionic Acidemia (PA). Two disorders share common biochemical and clinical features: accumulation of propionyl-coa and/or methylmalonate (MMA) and other metabolites is due to the absence of propionyl-coa carboxylase or methylmalonyl-coa mutase, respectively. The initial symptoms of PA and MMA include poor eating, vomiting, loss of appetite, weak muscle tone (hypotonia) and poor energy (lethargy). These symptoms sometimes develop into more serious medical problems, including cardiac abnormalities (cardiomyopathy), pancreatitis, seizures (seizurs), coma, and possibly even death.
Propionic acid is a precursor of propionyl-coa. The production of propionic acid in humans results from amino acid metabolism of dietary fiber in the gut, odd chain fatty acid metabolism and anaerobic bacterial fermentation. In addition to acetate and butyrate, propionate is one of the major Short Chain Fatty Acids (SCFA) produced in the gut by the microbiota. Most intestinal symbionts (commensals) from healthy adults carry genes for at least one of three known metabolic pathways for propionic acid production. Even though the factors that determine which pathways are effective in any given human gut are not clear, the activity of the differential pathways may have an effect on the function of the gut flora. In other words, any change in the production of any major SCFA (e.g. propionic acid) may have an effect on the substrates used by the microbiota and the metabolites produced by the microbiota as a whole entity (collective entity). Different propionic acid production (or synthesis) pathways will have different effects on the overall SCFA production potential (not only that of propionic acid itself). It is estimated that at least 25% of the total propionic acid in MMA and PA patients is derived from intestinal bacteria, although this may be underestimated as the microbiota of MMA and PA patients is currently poorly characterised.
Fiber is an integral part of the normal diet and is widely recognized as an important component of healthy nutrition. There are many different types of fibers, which are generally classified as soluble or insoluble, and may be further classified as fermentable, non-fermentable, or recalcitrant. Fibers have been shown to have a number of beneficial effects on intestinal health, including improving stool consistency, normalizing intestinal transit time, producing short chain fatty acids, and restoring balanced intestinal flora composition. Not all types of fibers have the same qualitative or quantitative effect. The full benefit of fiber to health is best achieved by consuming a variety of fiber sources. Fermentable fibers are important for the production of short chain fatty acids and restoration of a balanced microbiota. Poorly fermented fibers can increase stool volume, consistency, and viscosity, and may help reduce bacterial translocation.
Although fermentable fibers are considered beneficial because they increase the levels of short chain fatty acids in the large intestine, such an increase may be disadvantageous for MMA and PA patients, as the levels of propionic acid may increase as a result.
The prior art nutritional products for MMA and PA patients currently in use typically contain dietary fibre that is not optimized for the treatment of MMA and PA patients, because when the fibre present is fermented by the gut flora, large amounts of propionic acid are still produced. MMA/PA
Figure BDA0003002147840000021
Next and MMA/PA
Figure BDA0003002147840000022
junior contains a mixture of digested fibers to promote digestive health; the fiber mixture comprises fructo-oligosaccharide, inulin, acacia, cellulose, soybean polysaccharide and resistant starch. The product comprises a methionine-free, threonine-free and valine-free and low isoleucine amino acid composition. Both MMA/PA Anamix products are marketed to MMA/PA patients.
Knol et al (j.pediatr. gastroentereral nutr., vol 40(1), 1 month 2005) demonstrated that infant formulas comprising GOS/FOS in a 9:1 ratio were able to reduce the ratio of propionic acid to short chain fatty acids in the faeces of infants between 7 and 8 weeks of age. The publication does not mention the total amount of SCFA produced. Generally, the results of dietary fiber digestion cannot be inferred from infants to subjects of greater age. Older age subjects had a completely different microbiome compared to infants (Edwards and Parrett; Brit.J.Nutr.2002,88: suppl.1, S11-S18). This difference is usually attributed to the natural development of the gut, to the altered nutritional pattern, and in certain cases, such as disease and events using antibiotics. Hormonal changes during puberty may also further affect the microbiome. It is believed that the greatest change in microbiome occurs between 0 and 3 years of age.
Venkataman et al (Microbiome (2016),4:33) demonstrated that resistant starch (type 2) had no significant effect on propionic acid in the stool of young people.
The object of the present invention is to improve the known fibre compositions for MMA and PA patients to optimize the overall health effect of the fibres by fermentation products (e.g. lactic and butyric acids) and at the same time limit the production of propionic acid when fermented by the gut flora.
Disclosure of Invention
The inventors have found that certain fibers and fiber blends are capable of modulating propionic acid production, which plays an important role in the clinical characteristics of MMA and PA patients, and thus also ameliorates gastrointestinal complications in these patients. The inventors found that even when the total amount of short chain fatty acids was increased, the production of propionic acid could be reduced. Thus, MMA and PA patients may benefit from the benefits of the dietary fiber mixture of the invention, while reducing propionic acid levels and thus improving their condition. The inventors have also unexpectedly demonstrated that these benefits also occur in the adult population.
The examples show that Galactooligosaccharides (GOS) or fiber mixtures comprising GOS lead to a lower than expected propionic acid production by the microbiome. The total amount of SCFA of these fibers also increased. Furthermore, the inventors have unexpectedly found that when GOS is combined with resistant starch, the level of propionic acid can be further reduced, whereas the prior art reports that resistant starch has no effect on propionic acid formation.
List of preferred embodiments
1. A composition comprising galactooligosaccharides for use in a human subject aged at least 3 years:
-treating and/or alleviating methylmalonic acidemia (MMA) and/or Propionic Acidemia (PA), and/or treating, alleviating and/or preventing symptoms associated therewith;
-dietary management of MMA and/or PA; and/or
-reduction of propionic acid production by the intestinal flora.
2. The composition for use according to embodiment 1, wherein the subject is at least 12 years of age, preferably at least 18 years of age.
3. The composition for use according to any one of the preceding embodiments, wherein the composition further comprises a resistant starch.
4. The composition for use according to any one of the preceding embodiments, wherein the composition further comprises gum arabic, soy polysaccharide, and at least one of fructo-oligosaccharides and inulin.
5. A composition comprising galacto-oligosaccharide, resistant starch, gum arabic, soy polysaccharide, and at least one of fructo-oligosaccharide and inulin for use in:
-treating and/or alleviating methylmalonic acidemia (MMA) and/or Propionic Acidemia (PA), and/or treating, alleviating and/or preventing symptoms associated therewith;
-dietary management of MMA and/or PA; and/or
-reduction of propionic acid production by the intestinal flora.
6. The composition for use according to any one of embodiments 1-5, wherein the composition comprises at least 10 wt.%, preferably at least 20 wt.%, most preferably at least 30 wt.% of resistant starch, based on the total weight of dietary fiber.
7. The composition for use according to any one of embodiments 1-6, wherein the composition comprises at least 20 wt.%, preferably at least 30 wt.%, most preferably at least 50 wt.% of a combination of resistant starch and galacto-oligosaccharide, based on the total weight of dietary fiber.
8. The composition for use according to any one of embodiments 1-7, wherein the composition further comprises a lactic acid producing bacterium, preferably selected from the group consisting of Bifidobacterium (Bifidobacterium) and Lactobacillus (Lactobacillus).
9. The composition for use according to any one of embodiments 1 to 8, wherein the composition further comprises guar gum.
10. The composition for use according to any one of embodiments 1-9, wherein the composition comprises less than 5 wt.% cellulose, based on the total weight of dietary fiber, preferably the composition does not comprise cellulose.
11. The composition for use according to any one of embodiments 1-10, wherein the composition is in the form of:
(i) a nutritional supplement, preferably wherein the supplement further comprises amino acids; or
(ii) A complete nutritional composition, wherein the nutritional composition further comprises a protein fraction, digestible carbohydrates, vitamins and minerals, preferably in the form of amino acids.
12. The composition for the use according to any one of embodiments 1-11, wherein the composition further comprises a protein fraction consisting essentially of free amino acids and dipeptides, preferably wherein the protein fraction is essentially free of valine, isoleucine, methionine and threonine.
13. The composition for use according to any one of embodiments 1-12, wherein the composition comprises DHA.
14. The composition for use according to any one of embodiments 1-13, wherein the composition comprises vitamin D and/or calcium, preferably vitamin D.
16. A composition comprising galacto-oligosaccharide, resistant starch, gum arabic, soy polysaccharide, and at least one of fructo-oligosaccharide and inulin.
17. The composition according to embodiment 16, wherein the amount of GOS is at least 5 wt.% of the dietary fiber in the composition and the resistant starch is at least 10 wt.%, preferably at least 20 wt.%, most preferably at least 30 wt.% of the dietary fiber in the composition.
18. The composition according to embodiment 16 or 17, wherein the composition comprises less than 5 wt% cellulose based on the total weight of dietary fiber, preferably wherein the composition does not comprise cellulose.
Detailed Description
The present invention relates to a composition comprising dietary fibres suitable for the dietary management of patients suffering from methylmalonate-emia (MMA) and/or propionate-emia (PA), and for the treatment and/or alleviation of methylmalonate-emia (MMA) or propionate-emia (PA) and/or the treatment, alleviation and/or prevention of symptoms associated therewith, and for reducing propionic acid production by the intestinal flora, while maintaining/increasing the production of other short chain fatty acids. The composition to be used in this respect is referred to as the composition of the invention and is defined in detail hereinafter.
Composition comprising a metal oxide and a metal oxide
The composition of the invention comprises at least one dietary fiber and may comprise further components as defined below. In a preferred embodiment, the composition further comprises a protein source consisting of a specially designed blend of free amino acids or dipeptides. The amino acid composition is a mixture of specifically selected amino acids that supports the growth of MMA/PA patients and, at the same time, supports the role of the selected dietary fiber in reducing propionic acid production.
The composition of the present invention may also be referred to as a nutritional composition. The composition may be in the form of a supplement that provides dietary fiber that can be administered to a patient in addition to a regular diet. If the composition of the invention is in the form of a supplement, it comprises dietary fibres and preferably a blend of amino acids. The supplement may also be referred to as a dietary or nutritional supplement and may take any form known in the art, including tablets, capsules, (reconstitutable) powders, liquids, and the like. The composition may also take the form of a total nutritional composition, which may be administered to a patient in place of one or more meals. If the composition of the invention is in the form of a total nutritional composition, it comprises dietary fibres, proteinaceous matter, digestible carbohydrates, vitamins and minerals. Preferably the total nutritional composition is in liquid form or in powder form intended to be reconstituted with a liquid. In one embodiment, the composition is a supplement. In one embodiment, the composition is a total nutritional composition. In one embodiment, the composition is in liquid form. The compositions of the invention are intended for use by patients suffering from MMA and/or PA and, as these patients are accustomed to a special diet to cope with their disease, administration of the compositions of the invention is readily carried out in their daily regimen.
The compositions are further defined below. As used herein, the term "about" means a range of +/-10%.
Test subject
When referring to a patient or subject, it refers to a human patient or subject.
In the context of the present invention, an infant is a subject from 0 to 1 year old, a toddler is a subject from 1 to 3 years old, a child is a subject from 3 to 12 years old, an adolescent is a subject from 12 to 18 years old, and an adult is a subject greater than 18 years old. Preferably the patient is older than 1 year, more preferably 3 years, even more preferably 12 years, even more preferably 14 years, most preferably 18 years. Preferably the patient is an infant, a toddler, a child, an adolescent or an adult.
At the end of the first year of life, infants have individually unique microbial characteristics that tend towards the typical microbiota of adults, such that at the age of 2-5 years of age, their microbiota closely resemble that of adults in terms of composition and diversity. Thus, the first 3 years of life is the most critical period for dietary intervention to improve growth and development. This is the period during which the gut flora (an asset critical for health and neurological development) is established, during which alterations in gut flora may profoundly affect the health and development of the host. Reference is made to Rodriguez et al "The composition of The gut microbiota through life, with an emulsion on early life" Microb. Ecol. health Dis. (2015); 26. these findings are particularly relevant for children, adolescents or adults; even more preferably the patient is a juvenile or adult, most preferably the patient is an adult.
Dietary fiber
The composition of the invention comprises dietary fibre, which term also encompasses mixtures of dietary fibres. In one embodiment of the invention, the dietary fiber comprises galactooligosaccharides. In another embodiment of the invention, the dietary fiber comprises a mixture of galactooligosaccharides and resistant starch. In another embodiment, the dietary fiber is a mixture of galactooligosaccharides, resistant starch and other fibers. The inventors have unexpectedly found that the dietary fiber or mixture of dietary fibers of the present invention reduces the amount of propionic acid formed during anaerobic fermentation occurring in the intestinal tract.
In the context of the present invention, "fiber" and "dietary fiber" are used interchangeably. According to the present invention, the term dietary fiber means edible parts of plants or similar carbohydrates which are resistant to digestion and absorption in the human small intestine, and which are fully fermented, partially fermented or not fermented in the large intestine. This includes polysaccharides, oligosaccharides, lignin and related plant matter. Preferably, the dietary fibres used in the composition of the invention are selected from fermentable fibres and poorly fermentable and non-fermentable fibres. Preferably, the fibres of the mixture of dietary fibres used in the composition of the invention are selected from fermentable fibres and fibres which are poorly fermentable or non-fermentable fibres, more preferably a mixture of both types is used. Without being bound by theory, the inventors believe that constipation and defecation problems in patients with methylmalonic acidemia (MMA) and Propionic Acidemia (PA) are ameliorated by the use of these poorly or non-fermentable fibers. In one embodiment, the one or more poorly fermentable fibers or non-fermentable dietary fibers are selected from the group consisting of hemicellulose, lignin, alpha cellulose and resistant starch and mixtures thereof. In one embodiment, the one or more fermentable dietary fibers are selected from the group consisting of fructooligosaccharides, inulin, wheat bran, gum arabic, soy polysaccharide, oat fiber, galactooligosaccharides, locust bean gum, guar gum, pectin, hydrolyzed pectin, and mixtures thereof. In a preferred embodiment, the one or more dietary fibers are selected from the group consisting of fructooligosaccharides, inulin, resistant starch, cellulose, methyl cellulose (preferably hydroxypropyl methyl cellulose), wheat bran, gum arabic, soy polysaccharide, oat fiber, galacto-oligosaccharides, locust bean gum, guar gum, pectin, hydrolyzed pectin, and mixtures thereof. The terms "gum Arabic (Arabic)" and "gum Arabic (Arabic gum)" are used interchangeably.
In one embodiment, a fiber is used which is a galactooligosaccharide. Alternatively, a mixture of different dietary fibers is used, for example a mixture of at least 2, at least 3, at least 4, at least 5, at least 6 or even at least 7 different dietary fibers, preferably selected from the above list of preferred dietary fibers. Preferably, the mixture of fibers comprises at least galacto-oligosaccharides. Although the amount of different dietary fibers used in the context of the present invention is not particularly limited, for practical reasons a maximum of 10, a maximum of 9 or even a maximum of 8 different dietary fibers may be used. Preferred fibers (blends) are as follows:
(i) the fiber is galacto-oligosaccharide.
(ii) The fiber mixture comprises two fibers, one of which is galactooligosaccharide.
(iii) The fiber blend comprises two fibers, one of which is galactooligosaccharide and one of which is resistant starch.
(iv) The fibre blend comprises at least three, preferably at least four, at least five or at least six fibres, one of which is a galactooligosaccharide and one of which is a resistant starch.
(v) Fibre blend (ii) further comprising fructooligosaccharides and/or inulin, gum arabic and soy polysaccharide.
(vi) Fibre blend (iv) further comprising fructooligosaccharides and/or inulin, gum arabic and soy polysaccharide.
(vii) The fiber mixture (ii), (iii), (iv), (v) or (vi) further comprises guar and/or partially hydrolyzed guar.
(viii) A fiber blend comprising at least two, at least three, at least four, at least five, at least six, or all seven fibers selected from the group consisting of fructooligosaccharides, inulin, resistant starch, gum arabic, locust bean gum, galactooligosaccharides, and soy polysaccharide.
(ix) The fiber mixture (ii), (iv), (v), (vi), (vii) or (viii) does not contain cellulose.
(x) A fiber blend comprising at least two, at least three, at least four, at least five, at least six, at least seven, or all eight fibers selected from the group consisting of fructooligosaccharides, inulin, resistant starch, cellulose, gum arabic, locust bean gum, galactooligosaccharides, and soy polysaccharides.
A particularly preferred dietary fibre for use in the composition of the invention is GOS. GOS helps to balance the different SCFAs produced along the length of the colon and to improve stool loosening properties while reducing propionic acid formation. Preferably, GOS is combined with resistant starch. This combination combines the benefits of non-fermentable dietary fiber and fermentable dietary fiber.
Preferably GOS or a mixture of GOS and resistant starch is supplemented with other dietary fibers, preferably with a combination of gum arabic, soy polysaccharides and fructo-oligosaccharides and/or inulin. The fiber mixture closely reflects the range and type of fiber that is habitually consumed in the normal diet and further reduces propionic acid formation compared to GOS or a mixture of GOS and resistant starch. In a preferred embodiment, the amount of resistant starch is at least 10 wt%, more preferably at least 20 wt%, most preferably at least 30% of the dietary fiber in the composition. In a preferred embodiment, when the two GOS are present as resistant starch in a fiber mixture comprising more than 2 fibers, the sum of the amounts of resistant starch and galacto-oligosaccharide is at least 20 wt%, preferably at least 30 wt%, most preferably at least 50 wt% of the dietary fibers in the composition.
Preferably, the mixture of GOS, GOS and resistant starch or the fibers are supplemented with guar gum and/or partially hydrolysed guar gum supplemented with gum arabic, soy polysaccharides and a combination of fructo-oligosaccharides and/or inulin. Guar and/or partially hydrolyzed guar are fermentable fibers and may further act as taste masking agents, thus may support masking of any taste, such as bitterness of fibers and amino acids that may be included in the composition.
Preferably, the present composition comprises 0.4-50g dietary fibre per 100kcal, more preferably 0.6-30g/100kcal, most preferably 1-20g/100kcal, based on the total energy content of the composition (including fibre). If the composition of the invention is a total nutritional composition, the dietary fibre content is preferably 0.4-9g dietary fibre per 100kcal of the composition, even more preferably 0.6-7g/100kcal of the composition and most preferably 0.8-3g/100kcal of the composition. If the composition of the invention is a supplement, the dietary fibre content is preferably 2-50g dietary fibre per 100kcal of the composition, even more preferably 4-30g/100kcal of the composition and most preferably 5-20g/100kcal of the composition. The composition of the invention preferably comprises 1.5-5g dietary fibre/10 g protein, more preferably 2-4g dietary fibre/10 g protein and most preferably 2.5-3.5g dietary fibre/10 g protein. Preferably, the composition of the invention provides 2-40g dietary fibre, preferably 10-30g dietary fibre, in a daily dose. The actual dosage depends on the age of the patient. For infants and children up to 12 years of age, a preferred daily dose is 2-10g dietary fiber, and for adults a preferred dose is 7-30g dietary fiber. Even if the patient is still consuming low protein food (e.g. fruits and vegetables), it is recommended not to modify the daily dosage of the above-described fiber composition of the present invention in order to limit the propionic acid produced by the intestinal flora.
Preferred nutritional compositions of the invention comprise 70-250kcal/100ml of the nutritional composition, and 1-5g dietary fibre per 100kcal of the nutritional composition, more preferably 1.5-4.5g dietary fibre per 100kcal of the nutritional composition, even more preferably 2.0-4.0g dietary fibre per 100kcal of the nutritional composition. Such a composition was found to be particularly suitable for long-term dietary management of MMA and PA patients.
Galacto-oligosaccharides (GOS), also known as galacto-oligosaccharides (oligogalactyls), galacto-oligosaccharides (oligogalacttoses), galacto-oligosaccharides (oligolactitoses) or transgalacto-oligosaccharides (TOS), belong to the prebiotics (prebiotics). GOS typically comprise a chain of galactose units, with terminal glucose units, produced by a sequential transgalactosylation reaction. The degree of polymerization of GOS can vary very significantly, for example, in the range of 2-8 monomer units. In a preferred embodiment, the fiber mixture comprises galactooligosaccharides. The GOS may be present in the composition in up to 100 wt% of the total weight of the fibers, e.g. 0.5-100 wt%, preferably 1-100 wt% or even 5-100 wt%. Alternatively, other fibers are present and the GOS is preferably contained in the composition in an amount of 0.5-90 wt.%, preferably 0.5-70 wt.%, most preferably 1-30 wt.%, based on the total weight of the fibers.
Resistant Starch (RS) is any starch or starch digestion product that is not digested and absorbed in the stomach or small intestine and passed to the large intestine. The RS has been classified into four types. Any of these types are suitable for use in the present invention. RS1 refers to resistant starches that are not physically accessible or digestible, such as those found in seeds or legumes and unprocessed whole grains. RS2 refers to resistant starch that is not accessible to enzymes due to starch conformation (e.g., high amylose corn starch). RS3 refers to resistant starch formed when starch-containing food (e.g., pasta) is cooked and cooled. RS3 is produced as a result of retrogradation (retrogradation), which refers to an aggregation process in which dissolved starch becomes poorly soluble after being heated and dissolved in water and then cooled. RS4 refers to starch that has been chemically modified to resist digestion. In a preferred embodiment, the fiber blend comprises a resistant starch. If present, it is preferred that the resistant starch is included in the composition at 0.5 to 75 wt.%, preferably 3 to 50 wt.%, more preferably 10 to 40 wt.%, most preferably 15 to 30 wt.%, based on the total weight of the fiber.
Inulin is a heterogeneous collection of fructose polymers or Fructooligosaccharides (FOS). Inulin generally refers to material obtained from plant material and is itself commercially available. It consists of chain-terminating glucosyl moieties and repeating fructosyl moieties, which are linked by β (2,1) bonds. The polymerization Degree (DP) of standard inulin ranges from 2 to 60. After removal of the fraction with a DP below 10 during the preparation, the remaining product is called long chain FOS (lcFOS). The fraction with a DP below 10 may be referred to as short chain fructooligosaccharide or scFOS. In a preferred embodiment, the fiber mixture comprises inulin. If present, inulin is preferably contained in the composition in an amount of 0.5-40 wt.%, more preferably 5-30 wt.%, most preferably 10-25.5 wt.%, based on the total weight of the fiber.
In addition to inulin, preferably fructooligosaccharides are present in the fibre blend according to the invention. Fructooligosaccharides are fructooligosaccharides with a DP generally below 10 and are commercially available products, such as Orafti Oligofructose. In a preferred embodiment, the fibre blend comprises fructooligosaccharides. If present, it is preferred that the fructooligosaccharide is included in the composition in an amount of from 0.5 to 50 wt.%, preferably from 5 to 50 wt.%, most preferably from 5 to 28.4 wt.%, based on the total weight of the fiber.
Pectin, also known as pectic polysaccharides, is rich in galacturonic acid. Several different polysaccharides have been identified and characterized in the pectin group. Galacturonans are linear alpha- (1-4) -linked D-galacturonic acids. In nature, about 80% of the carboxyl groups of galacturonic acid are esterified with methanol. This ratio is reduced to various degrees during the pectin extraction process. The ratio of esterified to non-esterified galacturonic acid determines the behaviour of pectin in food applications. This is why pectins are classified as high-ester pectins versus low-ester pectins (HM pectins versus LM pectins), where more or less than half of the total galacturonic acid is esterified. Pectin can be hydrolyzed to reduce molecular weight. For the present application, hydrolyzed pectin is preferred to prevent an undesired viscosity increase. In a preferred embodiment, the fiber mixture comprises pectin. Preferably, pectin, if present, is included in the composition in an amount of 0.1 to 45 wt.%, preferably 0.2 to 27 wt.%, preferably 0.5 to 25 wt.%, based on the total weight of the fiber.
Cellulose is of the formula (C)6H10O5)nA polysaccharide consisting of a linear chain of hundreds to thousands of β (1 → 4) -linked D-glucose units. Cellulose is not digested or fermented in the human intestinal tract, and is therefore the fiber excreted in the faeces, and thus contributes to the consistency of the faeces. The fiber mixture may comprise cellulose. In a preferred embodiment, the fibre blend comprises less than 5% by weight cellulose relative to the dietary fibres in the composition, preferably no fibresAnd (4) vitamin. If present, cellulose may be present in the composition in an amount of from 0.5 to 5% by weight, preferably from 1 to 3% by weight, based on the total weight of the fibers. Alternatively, the cellulose may be present in 0.5 to 50 wt%, preferably 6 to 19.6 wt%, based on the total weight of the fiber.
Gum Arabic (Gum Arabic), also known as Gum Arabic (acacia Gum), is a natural Gum composed of hardened sap of various types of acacia trees. Arabinogalactans are biopolymers composed of arabinose and galactose monosaccharides. It is a major component of many vegetable gums, including gum arabic. In a preferred embodiment, the fiber mixture comprises gum arabic. Preferably, gum arabic, if present, is included in the composition in an amount of 0.1 to 40% by weight, preferably 1 to 15% by weight, based on the total weight of the fiber.
Locust bean gum is a galactomannan vegetable gum extracted from the seeds of the carob tree. It may be used in hydrolyzed or unhydrolyzed form. In a preferred embodiment, the fiber mixture comprises locust bean gum. Preferably, locust bean gum, if present, is included in the composition in an amount of 0.1 to 10 weight percent, preferably 0.5 to 3 weight percent, based on the total weight of the fiber.
Soy polysaccharide, also known as soy fiber, generally refers to a non-starch, highly insoluble polysaccharide isolated from soy. When soy polysaccharides are mentioned in the present invention, their DP is generally greater than 10, preferably greater than 20, more preferably greater than 50, even more preferably greater than 100. A suitable source of soy fiber is Fibrim (Solae). In a preferred embodiment, the fiber mixture comprises soy polysaccharide. If present, it is preferred that the soy polysaccharide is included in the composition in an amount of 0.01 to 10 wt.%, preferably 0.05 to 0.5 wt.%, based on the total weight of the fiber.
Guar gum is a galactomannan vegetable gum extracted from the seeds of guar. It may be used in (partially) hydrolyzed or unhydrolyzed form. In the context of the present invention, it is most preferred to use partially hydrolysed guar. In a preferred embodiment, the fiber mixture comprises partially hydrolyzed guar. In an alternative embodiment, the fiber blend does not include partially hydrolyzed guar gum as the only dietary fiber. If present, guar gum is preferably included in the composition in an amount of 0.01 to 10 weight percent, preferably 0.05 to 3 weight percent, based on the total weight of the fiber.
Lactic acid producing bacteria
Preferably the composition further comprises a lactic acid producing bacterium. Alternatively, the dietary fiber composition is administered with a composition comprising lactic acid producing bacteria. The inventors believe that the use of supplemental lactic acid producing bacteria can synergistically restore and balance the gut flora microbiota of MMA and PA patients, particularly if the presence of propionic acid producing bacteria is avoided, thereby providing a synergistic effect with dietary fibre. Thus, in one embodiment, the composition is substantially free of propionogen. Preferably at 108Colony Forming Unit to 1012The daily dosage of colony forming units provides the lactic acid producing bacteria comprised in the composition of the invention. Preferably, the lactic acid producing bacteria are selected from low propionic acid producing bacteria. Preferably, the composition of the invention comprises bifidobacteria and/or lactobacilli. Preferred strains to be included in the composition of the invention include lactobacillus plantarum (preferably WCFS1) and/or Bifidobacterium adolescentis (preferably DSM 18350).
Protein
Preferably, the composition of the invention further comprises a protein fraction. Preferably, the composition is free of intact proteins and partially hydrolyzed proteins, and the protein fraction consists essentially of free amino acids and dipeptides. Thus, the protein levels defined hereinafter preferably apply to amino acids only. The term "protein equivalent" is well known in the art and refers to the amount of free amino acids as if they were part of a protein, i.e. the weight value of an amino acid is understood as the protein equivalent weight value. Typically, the contribution of amino acids to the protein represents about 81% by weight of the respective amino group.
Amino acids are essential for maintaining the cellular mass of the body and almost all major bodily functions. Dietary protein serves as a source of essential amino acids and provides nitrogen for the synthesis of other amino acids and nitrogen-containing compounds of physiological importance. Organic aciduria is caused by the inability of the human body to break down certain precursor amino acids (valine, isoleucine, methionine and threonine) in proteins. It is therefore preferred that these amino acids are restricted or even completely excluded from the composition of the invention. In other words, in a preferred embodiment, the protein fraction is substantially free of at least two, more preferably at least three, most preferably at least four of valine, isoleucine, methionine and threonine.
The following table shows a summary of the preferred amino acid profile of the invention in g/10g protein equivalents.
Figure BDA0003002147840000121
Figure BDA0003002147840000131
The preferred content of amino acids in the table above applies to each amino acid individually as well as to the entire amino acid spectrum. Notably, the contribution of each individual amino acid weight to the total protein equivalent weight was about 80%.
Preferably, the composition of the invention comprises 0-50 wt.% protein equivalents based on dry weight of the composition, even more preferably 0-40 wt.% protein equivalents and most preferably 20-35 wt.% protein equivalents based on dry weight of the composition. If the composition of the invention is a nutritional composition, it may preferably comprise 10-60 wt.%, preferably 20-50 wt.%, more preferably 25-35 wt.%, most preferably about 28 wt.% protein equivalents (preferably amino acids), based on dry weight. The composition of the invention preferably comprises 2.5-10g amino acids per 100kcal of composition per energy unit, preferably 4-9.5g amino acids per 100kcal of composition, most preferably 5-8.0g amino acids per 100kcal of composition. Preferably, the composition of the invention comprises less than 1.0 wt% of each amino acid, more preferably less than 0.5 wt% of each amino acid, even more preferably less than 0.1 wt% of each amino acid and most preferably 0.0 to 0.05 wt% of each amino acid, based on the total weight of amino acids in the composition; the amino acid is selected from isoleucine, valine, threonine and methionine. In a preferred embodiment, the composition of the invention further comprises carnitine, preferably at least 0.01 wt% carnitine, more preferably 0.05-7.5 wt% carnitine, more preferably 0.05-5 wt% carnitine, based on the total weight of amino acids in the composition.
The optimal protein content provided to a patient will generally depend on the amount of composition prescribed by a physician or dietician based on the computational requirements of the individual patient. Depending on age and clinical condition, the average protein requirement may vary from 1 to 3g/kg body weight per day. In one embodiment, the compositions of the invention comprise sufficient protein to provide 60-100% by weight of the recommended daily intake, as suggested by the Medical Research Council (MRC) in the dietary management of Phenylketonuria (Recommendations on the diet management of Phenylketonuria) Report on Phenylketonuria by the Medical Research Committee Working group (Report of Medical Research Council Working on phenyl ketonuria) Arch disc Child, 1993.63 (3): p.426-427. In an alternative embodiment, the composition of the invention comprises sufficient protein to provide up to 60% by weight of the recommended daily intake as listed by MRC, which is particularly preferred if the composition of the invention is in the form of a supplement.
Lipid
The compositions of the present invention preferably further comprise a lipid fraction. Lipids are an important energy source for children and are able to utilize amino acids. Certain fatty acids, such as long chain polyunsaturated fatty acids (LCPUFAs), are believed to be beneficial for protein-restricted diets. The intake of LCPUFA in children with inborn errors of amino acid metabolism is often limited because LCPUFA are mainly present in animal-derived food products and dietary therapy requires the exclusion of this naturally abundant protein source from the diet. Lipids also store fat-soluble vitamins and are a source of essential fatty acids. The total lipid content of preferred embodiments is preferably 2.5-9g lipid/100 kcal, more preferably 3-7.5g lipid/100 kcal, even more preferably 3.5-6g lipid/100 kcal and most preferably about 4.5g lipid/100 kcal or about 12.5-25g lipid/100 g dry weight of the composition. Preferably, the lipid source is a blend of vegetable oils (e.g. rapeseed-sunflower oil-palm kernel oil-coconut oil blend) that provides a percentage of saturated fatty acids (16.6 wt% fat), polyunsaturated fatty acids (15.0 wt% fat) and monounsaturated fatty acids (68.4 wt% fat). Preferably the nutritional composition of the invention comprises essential fatty acids, linoleic acid (C18:2(n-6)) and alpha-linolenic acid (C18:3(n-3), and is preferably present in amounts (3-10 wt% and 0.5-4.5 wt% of the total weight of lipids) consistent with current recommendations the ratio of n-6 to n-3 fatty acids is preferably 6:1-1:1, more preferably 3:1-2:1, most preferably about 2.6:1 docosahexaenoic acid (22:6n-3, DHA) is the important omega-3 Long Chain Polyunsaturated (LCP) fatty acid as it is the most predominant fatty acid in nervous tissue it comprises about 20% of all fatty acids in the brain and up to 60% of all fatty acids in the retina (eye). DHA is responsible for the formation of the neural membrane, the integrity of the membrane, electrical insulation, Vesicle trafficking and synaptic transmission are critical. Studies have shown that the efficiency of the conversion of DHA from its precursor essential fatty acid ALA is less than what is normally assumed. Since it has been found that DHA is deficient in the diet and plasma of PKU subjects after a restricted diet, and also in subjects with other inborn errors of metabolism, the DHA level comprised in the composition of the invention is 20-120mg/100kcal, preferably 30-90mg/100kcal, even more preferably 35-85mg/100kcal, most preferably about 65mg/100 kcal. The source of DHA is preferably seaweed, which has minimal impact on the taste of the final product compared to sources from fish oil.
Digestible carbohydrates
Preferably the present composition further comprises a digestible carbohydrate moiety. Carbohydrates are classified into monosaccharides, disaccharides, oligosaccharides and polysaccharides. Digestible carbohydrates include important biomolecules that are an important source of energy. Preferably, the total carbohydrate content of the composition of the invention is 0-50g/100kcal, preferably 20-40g/100kcal, most preferably about 30g/100 kcal. Preferably, the source of carbohydrate in the present composition comprises, preferably is maltodextrin. The use of maltodextrin increases solubility and reduces the contribution to the osmolality of the formulation compared to, for example, glucose or sucrose.
Micronutrients
Preferably the composition of the invention further comprises micronutrients. Preferably, the compositions of the present invention comprise vitamins, minerals and trace elements in amounts that satisfy RDA/DRI and DRV between 1 and 3 years of age, based on typical product usage (see, for example, Institute of Medicine, Dietary Reference for Calcium and Vitamin D, National Academy Press, Editor 2010: Washington D.C.). In particular, vitamin D and calcium are increased according to the newly suggested intake, as discussed below. Sodium and potassium were intentionally reduced to optimize taste.
In a preferred embodiment, the composition of the invention comprises vitamin D and/or calcium, preferably vitamin D.
The main source of vitamin D in humans is exposure to sunlight, and any situation that prevents sun exposure or interferes with the penetration of UVB into the skin affects vitamin D synthesis. Dietary sources for vitamin D are few. The main sources are fatty fish, fish oil, liver and other organ meat, and egg yolk of chickens fed vitamin D, which are usually excluded from the restricted diet of patients with inborn errors of metabolism. Vitamin D deficiency in children leads to growth retardation and the typical signs and symptoms of rickets. Vitamin D is critical for bone health and, since it lays the foundation for bone health in adults in the early years, proper intake of vitamin D is critical in childhood. Suboptimal vitamin D status and/or suboptimal exposure to sunlight is also associated with muscle weakness, functional deficits, cardiovascular disease, cancer mortality, and potentially longer hospital stays for hospitalized patients. In addition, vitamin D has a critical role in supporting serum calcium concentrations within a narrow range and is crucial for maximizing calcium absorption in the small intestine. It is estimated that adequate vitamin D status increases calcium absorption to 30-40% compared to increasing calcium absorption to 10-15% when vitamin D status is inadequate. Factors affecting vitamin D status include race, malnutrition, advanced age, use of various vitamins and uv irradiation. It is expected that patients with inborn errors of metabolism will have very limited vitamin D intake from their normal diet. Thus, the composition of the present invention preferably comprises 2-20. mu.g/100 kcal, more preferably 4-17. mu.g/100 kcal, most preferably 5-14. mu.g/100 kcal (200-560IU/100kcal) of vitamin D.
Calcium is an essential nutrient for bone and tooth mineralization. In addition, calcium is used as a signal for many cellular processes (e.g., secretion of hormones, enzymes, and the nervous system). Calcium and vitamin D are closely related to each other. The main physiological function of vitamin D is to maintain serum calcium and phosphorus levels within normal ranges to support, for example, metabolic function, bone mineralization. Vitamin D helps maintain calcium homeostasis if calcium intake is inadequate. However, this prevents efficient absorption of calcium when vitamin D is deficient. Preferably, the compositions of the present invention comprise calcium at a level of 200-600mg/100kcal, more preferably 250-500mg/100kcal, and most preferably about 375mg/100 kcal. The calcium content is preferably 500-1500mg, more preferably 800-1200mg, most preferably about 980mg per 100g dry weight of the composition.
Density of heat quantity
In a preferred embodiment, the composition of the invention is a supplement comprising only dietary fibres. Thus, the fibers constitute about 90-100% of the energy of the composition. In another preferred embodiment, the composition of the invention is a supplement comprising only dietary fiber and protein. In the latter embodiment, the energy density of the protein is preferably 4-98 energy%, and the energy density of the dietary fiber is preferably 2-96 energy%. In another preferred embodiment, the composition of the invention is a total nutritional composition comprising dietary fibre, protein, digestible carbohydrates and lipids, wherein the energy density is preferably as follows: 10-60% by energy of lipid, 10-65% by energy of digestible carbohydrate, 2.0-15% by energy of dietary fiber and 10-40% by energy of protein. The energy density of the total nutritional composition is preferably 0.4-3.5kcal/ml, more preferably 0.7-3.0kcal/ml, even more preferably 0.8-2.6kcal/ml and most preferably 0.9-2.4 kcal/ml. Herein, "comprising only" means that substantially no other components are present and all energy densities of the components are given as a percentage of the total energy content of the composition.
Particularly preferred compositions
In one aspect of the invention, the invention relates to the composition as defined above per se. In the context of this aspect, the composition of the invention preferably comprises dietary fibers and a protein fraction consisting of free amino acids. Particularly preferred compositions of the invention comprise galacto-oligosaccharides, resistant starch, gum arabic, soy polysaccharides, and at least one of fructo-oligosaccharides and inulin, preferably in combination with a protein fraction consisting of free amino acids, more preferably wherein the free amino acids are substantially free of valine, isoleucine, methionine and threonine. Another preferred composition comprises at least one dietary fiber selected from the group consisting of fructooligosaccharides, inulin, resistant starch, cellulose, methylcellulose, wheat bran, gum arabic, soy polysaccharide, oat fiber, galacto-oligosaccharides, locust bean gum, pectin, guar gum, and mixtures thereof, and free amino acids are substantially free of valine, isoleucine, methionine, and threonine. Preferably, the dietary fiber comprises at least GOS. Preferably, the composition further comprises lactic acid bacteria. Particularly preferred compositions of the present invention further comprise 10-60% energy lipid and 10-65% energy digestible carbohydrate, wherein dietary fibre is present at 2.0-25% energy and protein is present at 10-40% energy of the total composition, wherein the energy density of the composition is 0.7-3.5kcal/ml.
Administration of
In a first aspect, the composition of the invention comprising dietary fiber is used for dietary Management of Methylmalonic Acidemia (MMA) and/or Propionic Acidemia (PA). In other words, the present invention relates to the use of dietary fiber for the preparation of a composition for the dietary Management of Methylmalonic Acidemia (MMA) and/or Propionic Acidemia (PA). In other words, the present invention relates to a method for dietary Management of Methylmalonic Acidemia (MMA) and/or Propionic Acidemia (PA) comprising administering to a subject in need thereof a composition of the invention comprising a therapeutic amount of dietary fiber.
Furthermore, the composition of the invention comprising dietary fibers is useful for the treatment and/or alleviation of methylmalonic acidemia (MMA) and/or Propionic Acidemia (PA), and/or the treatment, alleviation and/or prevention of symptoms associated therewith. In other words, the present invention relates to the use of dietary fiber for the preparation of a composition for the treatment and/or alleviation of methylmalonate-emia (MMA) and/or propionate-emia (PA), and/or the treatment, alleviation and/or prevention of symptoms associated therewith. In other words, the present invention relates to a method for treating and/or reducing methylmalonic acidemia (MMA) and/or Propionic Acidemia (PA), and/or treating, reducing and/or preventing symptoms associated therewith, comprising administering to a subject in need thereof a composition of the present invention comprising a therapeutic amount of dietary fiber.
Furthermore, the composition of the invention comprising dietary fiber is used for reducing propionic acid production by the intestinal flora. In other words, the present invention relates to the use of dietary fiber for the preparation of a composition for reducing propionic acid production by the intestinal flora. In other words, the present invention relates to a method for reducing propionic acid production by the gut flora comprising administering a composition of the present invention comprising a therapeutic amount of dietary fiber to a subject in need thereof.
The use according to the invention described herein applies equally to the method according to the invention and to the composition used according to the invention. These uses are medical in nature. The target population for these uses is patients with MMA and/or PA. The use according to the invention generally relates to reducing propionic acid produced by the intestinal flora as measured in the faeces of a patient.
The use according to the first aspect may also be for the treatment and/or alleviation of MMA or PA, and/or the treatment, alleviation and/or prevention of symptoms associated therewith. In one embodiment, the use according to the first aspect is also for the treatment and/or alleviation of MMA or PA. In one embodiment, the use according to the first aspect is also for the treatment, alleviation and/or prevention of symptoms associated with MMA and/or PA.
In one embodiment, the use according to the second aspect is for the treatment and/or alleviation of MMA and/or PA. In one embodiment, the use according to the second aspect is for the treatment, alleviation and/or prevention of symptoms associated with MMA and/or PA. The use according to the second aspect may also be used for dietary management of MMA and/or PA. Treating, alleviating and/or preventing symptoms may also be referred to as alleviating symptoms.
Symptoms associated with MMA and/or PA may also be referred to as symptoms associated with excess production of propionic acid in the gut and generally include gut diseases, diseases associated with vitamin D deficiency and diseases associated with LC-PUFA deficiency. Intestinal disease in MMA and/or PA patients typically includes one or more of the following: imbalances in microbiota, bacterial translocation, impaired loose stools, impaired intestinal transit time, imbalances in SCFA production and constipation. In one embodiment, the bowel disease is selected from impaired loose stool, an imbalance in SCFA production, and constipation. Loose stool products include volume, consistency and viscosity. Reducing unbalanced SCFA production preferably comprises balancing SCFA production along the length of the colon. Diseases associated with vitamin D deficiency in MMA and/or PA patients typically include one or more of the following: growth retardation, rickets, impaired skeletal health, muscle weakness, functional defects, cardiovascular disease, cancer mortality, and impaired calcium intake. Diseases associated with LC-PUFA deficiency (especially DHA deficiency) include brain diseases such as impaired neural membrane integrity, impaired electrical insulation, impaired vesicle trafficking, and impaired synaptic transmission. These symptoms associated with MMA and/or PA are treated, reduced and/or prevented by administration of the compositions of the invention. In a preferred embodiment, intestinal disorders associated with MMA and/or PA are treated, alleviated and/or prevented.
Example 1
Fermentation of
In a high throughput anaerobic colon model (I-screen)TMPlatform, TNO, Zeist, netherlands) for 24 hours, the effect of the fiber mixture of table 1 on SCFA was measured. This platform mimics the intestinal flora conditions and allows determination of the effect of compounds on microbiota composition over time under strictly anaerobic conditions. Inoculation of I-Screen with Standard adult human intestinal floraTMAnd (4) modeling. The intestinal flora is obtained by adopting the following method: a standardized microbiota was generated by combining fecal samples from 6 healthy adult volunteers and incubating the combined fecal samples in a fed-batch fermenter for 40 h. The pooled fecal samples were then placed in modified standard ileal effluent medium (standard)ileal effluxum medium, SIEM) and the pH was adjusted to 5.8. The standard adult human intestinal flora was stored in 12% glycerol at-80 ℃ until further analysis. This combination approach is intended to limit inter-individual variation and to increase the likelihood of having a larger representation of potential bacterial species in the human colon.
Prior to testing the fiber mixture, activation was achieved by incubating the standard adult microbiota in modified SIEM medium under anaerobic conditions at 37 ℃ and shaking at 300rpm overnight. 4 conditions were tested at a concentration of 6mg/ml (fiber level concentration), corresponding to different combinations of fiber mixtures and components (Table 1). Negative controls (SIEM medium unexposed microbiota) and blanks (SIEM medium without microbiota) were included. Each condition (including control) was tested in triplicate. Table 1 summarizes the experimental setup. After addition of (a combination of) test compounds, negative control or blank, the microbiota was incubated anaerobically at 37 ℃ for 24 hours. Samples were then collected and subjected to further analysis.
Short Chain Fatty Acid (SCFA) measurement
For analysis of short chain fatty acids, the reagent pair I-screenTMThe resulting material was incubated for sampling and centrifuged at 4,000g for 5 minutes. The supernatant was filter sterilized with a 0.45pm filter. A mixture of formic acid (20%), methanol and 2-ethylbutyric acid (internal standard, 2mg/ml in methanol) was added. In an Shimadzu GC-2014 gas chromatograph, a 3 picoliter (pl) sample with a split ratio of 75.0 was injected into a GC column (ZB-5HT interferno, ID 0.52mm, film thickness 0.10 um; Zebron; phenomenex, USA). SCFAs analyzed were acetic acid, propionic acid, isobutyric acid, n-butyric acid, and isovaleric acid.
Results
The amount of propionic acid produced by the fiber mixture and the percentage of propionic acid relative to total SCFA after 24 hours anaerobic in vitro fermentation with adult microbiome is shown in table 2. Mixtures A, B, D, E and F reduced propionic acid formation and increased the total amount of SCFA formed compared to the control, while mixture C caused an increase in propionic acid formation. Moreover, mixture b (gos) showed the greatest effect relative to mixtures a and C, both in terms of propionic acid formation and SCFA formation. This was followed by blend D, which showed an increase in the level of resistant starch (at the expense of cellulose) compared to blend A, indicating a decrease in propionic acid relative to blend A. The total amount of SCFA was also higher for mixture D compared to mixture a. The addition of 10 wt.% GOS to mixture D further reduced the amount of propionic acid in the resulting mixture F.
The effect of GOS on propionic acid seems to be higher when relatively large amounts of resistant starch are present. Mixture F shows improved effect compared to mixture E versus mixture a versus mixture D.
Conclusion
The inventors have found that the fibre blend of the present invention results in lower levels of propionic acid production in the adult microbiome. Specifically, propionic acid production of mixtures B, D and F was unexpectedly low, while maintaining high yields of other SCFAs. This indicates that the fiber composition of the present invention comprising fibers may play an important role in the clinical characteristics of patients with methylmalonic acidemia (MMA) and Propionic Acidemia (PA).
TABLE 1 composition of the fiber blends tested (weight percent of each fiber relative to the total fiber).
Figure BDA0003002147840000211
Table 2: propionic acid produced during in vitro fermentation (average of 3 measurements).
Figure BDA0003002147840000212
Example 2: compositions of the invention
The following compositions of the invention are compositions suitable for the treatment of MMA and PA by modulating the intestinal flora such that propionic acid production is reduced. The supplement comprises the following ingredients in weight%, based on the total weight of the composition:
1.5-28.4% fructooligosaccharides
1.5-25.5% inulin
1.5-50% resistant starch
1-15% acacia gum
0-0.5% Soy polysaccharide
0-3% guar gum
5-79.5% galacto-oligosaccharides
Optionally supplemented with lactic acid producing bacteria, preferably bifidobacteria and/or lactobacilli.
Example 3: compositions of the invention
The following compositions of the invention are compositions suitable for the treatment of MMA and PA by modulating the intestinal flora such that propionic acid production is reduced. The supplement comprises the following ingredients in weight%, based on the total weight of the composition:
5-100% galacto-oligosaccharides
0-70% resistant starch
Optionally supplemented with lactic acid producing bacteria, preferably bifidobacteria and/or lactobacilli.
Optionally a lipid source and a digestible carbohydrate source.
Example 4: compositions of the invention
The following compositions of the invention are such: it is used for the treatment and/or dietary management of MMA or PA patients by modulating the intestinal flora and supplementing proteins such that the levels of toxic metabolites in the blood are reduced. The composition comprises the fiber blend of example 2 and an amino acid blend comprising the following amino acids in g/per 10 gram protein equivalent:
Figure BDA0003002147840000221
Figure BDA0003002147840000231
example 5: compositions of the invention
The following compositions of the invention are total nutritional compositions for the treatment and/or dietary management of MMA or PA patients by modulating the intestinal flora and supplementing proteins such that the levels of toxic metabolites in the blood are reduced. The composition can be used as exclusive diet (exclusive diet). The supplement comprises the fiber and protein blend of example 3, lipids, digestible carbohydrates and micronutrients.
Figure BDA0003002147840000232
Figure BDA0003002147840000241
Figure BDA0003002147840000251
Note
The term "protein equivalent" is well known in the art and refers to the amount of free amino acids as if they were part of a protein, i.e. the weight value of an amino acid is to be understood as the protein equivalent weight value. The contribution of amino acids to the protein represents about 81% by weight of the respective amino group.

Claims (17)

1. A composition comprising galactooligosaccharides for use in a human subject having an age of at least 3 years:
-treating and/or alleviating methylmalonic acidemia (MMA) and/or Propionic Acidemia (PA), and/or treating, alleviating and/or preventing symptoms associated therewith;
-dietary management of MMA and/or PA; and/or
-reduction of propionic acid production by the intestinal flora.
2. The composition for use according to claim 1, wherein the subject is at least 12 years of age, preferably at least 18 years of age.
3. The composition for use according to any one of the preceding claims, wherein the composition further comprises a resistant starch.
4. The composition for use according to any one of the preceding claims, wherein the composition further comprises gum arabic, soy polysaccharide, and at least one of fructo-oligosaccharides and inulin.
5. A composition comprising galacto-oligosaccharide, resistant starch, gum arabic, soy polysaccharide, and at least one of fructo-oligosaccharide and inulin for use in:
-treating and/or alleviating methylmalonic acidemia (MMA) and/or Propionic Acidemia (PA), and/or treating, alleviating and/or preventing symptoms associated therewith;
-dietary management of MMA and/or PA; and/or
-reduction of propionic acid production by the intestinal flora.
6. The composition for use according to any one of claims 1-5, wherein the composition comprises at least 10 wt.%, preferably at least 20 wt.%, most preferably at least 30 wt.% of resistant starch, based on the total weight of dietary fiber.
7. The composition for use according to any one of claims 1-6, wherein the composition comprises at least 20 wt.%, preferably at least 30 wt.%, most preferably at least 50 wt.% of a combination of resistant starch and galacto-oligosaccharide, based on the total weight of dietary fiber.
8. The composition for use according to any one of claims 1-7, wherein the composition further comprises a lactic acid producing bacteria, preferably selected from the group consisting of Bifidobacterium and Lactobacillus.
9. The composition for use according to any one of claims 1-8, wherein the composition further comprises guar gum.
10. The composition for use according to any one of claims 1-9, wherein the composition comprises less than 5 wt.% cellulose, based on the total weight of dietary fiber, preferably the composition does not comprise cellulose.
11. The composition for use according to any one of claims 1-10, wherein the composition is in the form of:
(i) a nutritional supplement, preferably wherein the supplement further comprises amino acids; or
(ii) A total nutritional composition, wherein the nutritional composition further comprises a protein fraction, digestible carbohydrates, vitamins and minerals, preferably the protein fraction is in the form of amino acids.
12. The composition for the use according to any one of claims 1-11, wherein the composition further comprises a protein fraction consisting essentially of free amino acids and dipeptides, preferably wherein the protein fraction is essentially free of valine, isoleucine, methionine and threonine.
13. The composition for use according to any one of claims 1-12, wherein the composition comprises DHA.
14. Composition for use according to any one of claims 1-13, wherein the composition comprises vitamin D and/or calcium, preferably vitamin D.
15. A composition comprising galacto-oligosaccharide, resistant starch, gum arabic, soy polysaccharide, and at least one of fructo-oligosaccharide and inulin.
16. Composition according to claim 15, wherein the amount of GOS is at least 5 wt.% of the dietary fibres in the composition and the resistant starch is at least 10 wt.%, preferably at least 20 wt.%, most preferably at least 30 wt.% of the dietary fibres in the composition.
17. The composition according to claim 15 or 16, wherein the composition comprises less than 5 wt% cellulose based on the total weight of dietary fiber, preferably wherein the composition does not comprise cellulose.
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